The rate of active progressive HIV encephalopathy in children with HIV infection receiving highly active antiretroviral therapy was less than 2% and the cumulative prevalence of arrested disease was 10%, results from a prospective study demonstrated.
“In the era of HAART, HIV has been transformed from an invariably fatal disease to a chronic disease in which survival is expected,” Claudia Chiriboga, M.D., of the division of pediatric neurology at Columbia University Medical Center, New York, and her associates said. “PHE in the post-HAART era is thus an infrequent and reversible complication of HIV infection that responds to effective antiretroviral control and that may relapse if viral control is lost.”
Few studies have sought to determine the incidence of progressive HIV encephalopathy (PHE) since HAART was introduced in the late 1990s. Dr. Chiriboga and her associates prospectively evaluated 126 children with HIV who have been assessed yearly by a neurologist at Harlem Hospital Center since 1988 (J. Pediatr. 2005;146:402–7).
The children received baseline evaluations from a pediatrician and neurologist in 2000. The investigators reviewed medical records for HIV disease manifestations, antiretroviral treatment, and immunologic and virologic measures. They also assessed the children for PHE, developmental delay, and attention-deficit hyperactivity disorder.
All children had been perinatally infected with HIV. Half were male, and only 11 were older than 3 years. Their mean age at baseline evaluation was 23 months, and they were followed for an average of 82 months.
The investigators observed that in 2000, the rate of active PHE was 1.6% (2 children), and the prevalence of arrested PHE was 10% (13 children). They also found that the majority of survivors experienced residual motor and cognitive sequelae and needed special education.
Other observations were that PHE relapse occurred in three children with previously arrested PHE, viral load was the only significant risk factor associated with PHE, and neither HIV nor PHE was associated with the development of ADHD.
The findings suggest that, “as refers to PHE progression, viral load should be monitored [as well as CD4 count] in order to achieve a more comprehensive appraisal of progression of HIV disease,” the investigators said.